Jennifer M Perez, Matt Hall, Robert J Graham, Jay G Berry
{"title":"脊柱融合术中医疗复杂性患儿术后机械通气:儿童健康信息系统数据库,2016-2021队列","authors":"Jennifer M Perez, Matt Hall, Robert J Graham, Jay G Berry","doi":"10.1097/PCC.0000000000003827","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To assess the prevalence and factors associated with duration of postoperative invasive mechanical ventilation (IMV) in children with medical complexity undergoing spinal fusion.</p><p><strong>Design: </strong>Retrospective cohort study of the Pediatric Health Information System database.</p><p><strong>Setting: </strong>Forty-seven tertiary referral U.S. children's hospitals.</p><p><strong>Patients: </strong>Patients 5-18 years old with an underlying neuromuscular or genetic disorder admitted to the ICU following thoracic-lumbar spinal fusion for scoliosis, with hospital discharge between January 1, 2016, and December 31, 2021.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>There were 6511 patients who met inclusion criteria, of which 438 (6.7%) had established preoperative tracheostomy and ventilator dependence. Three hundred seventy-two (5.7%) and 458 (7%) patients underwent postoperative IMV for 4-6 days and greater than or equal to 7 days, respectively. Chronic conditions associated with greater odds of greater than or equal to 4 days of postoperative IMV (as shown by adjusted odds ratio [aOR, 95% CI]), included diseases affecting the following systems: neurologic (aOR, 3.5; 95% CI, 2.5-5.0), respiratory (aOR, 2.8; 95% CI, 2.3-3.5), skin/subcutaneous tissue (aOR, 1.5; 95% CI, 1.2-2.1), hematologic (aOR, 1.4; 95% CI, 1.1-1.7), endocrine/metabolic (aOR, 1.3; 95% CI, 1.1-1.6), genitourinary (aOR, 1.3; 95% CI, 1.1-1.7), and cardiac (aOR, 1.3; 95% CI, 1.0-1.7). Established preoperative tracheostomy was associated with lower odds of greater than or equal to 4 days of postoperative IMV (aOR, 0.1; 95% CI, 0.02-0.3). New tracheostomy procedures were uncommon (n = 43, 0.7%). Finally, there was substantial regional variation in postoperative IMV after spinal fusion, with patients in the Northeast vs. Midwest region having greater odds of greater than or equal to 4 days of postoperative IMV (aOR, 3.1; 95% CI, 1.9-5.0).</p><p><strong>Conclusions: </strong>One-in-eight children required greater than or equal to 4 days of IMV after spinal fusion. Chronic conditions affecting the neurologic, respiratory, skin/subcutaneous tissue, hematologic, endocrine/metabolic, genitourinary, and cardiac systems were associated with postoperative IMV. Further understanding of chronic conditions, clinical characteristics, and regional factors associated with duration of IMV may identify opportunities for improvements in care delivery.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Postoperative Mechanical Ventilation for Children With Medical Complexity Undergoing Spinal Fusion: A Pediatric Health Information System Database, 2016-2021 Cohort.\",\"authors\":\"Jennifer M Perez, Matt Hall, Robert J Graham, Jay G Berry\",\"doi\":\"10.1097/PCC.0000000000003827\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To assess the prevalence and factors associated with duration of postoperative invasive mechanical ventilation (IMV) in children with medical complexity undergoing spinal fusion.</p><p><strong>Design: </strong>Retrospective cohort study of the Pediatric Health Information System database.</p><p><strong>Setting: </strong>Forty-seven tertiary referral U.S. children's hospitals.</p><p><strong>Patients: </strong>Patients 5-18 years old with an underlying neuromuscular or genetic disorder admitted to the ICU following thoracic-lumbar spinal fusion for scoliosis, with hospital discharge between January 1, 2016, and December 31, 2021.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>There were 6511 patients who met inclusion criteria, of which 438 (6.7%) had established preoperative tracheostomy and ventilator dependence. Three hundred seventy-two (5.7%) and 458 (7%) patients underwent postoperative IMV for 4-6 days and greater than or equal to 7 days, respectively. Chronic conditions associated with greater odds of greater than or equal to 4 days of postoperative IMV (as shown by adjusted odds ratio [aOR, 95% CI]), included diseases affecting the following systems: neurologic (aOR, 3.5; 95% CI, 2.5-5.0), respiratory (aOR, 2.8; 95% CI, 2.3-3.5), skin/subcutaneous tissue (aOR, 1.5; 95% CI, 1.2-2.1), hematologic (aOR, 1.4; 95% CI, 1.1-1.7), endocrine/metabolic (aOR, 1.3; 95% CI, 1.1-1.6), genitourinary (aOR, 1.3; 95% CI, 1.1-1.7), and cardiac (aOR, 1.3; 95% CI, 1.0-1.7). Established preoperative tracheostomy was associated with lower odds of greater than or equal to 4 days of postoperative IMV (aOR, 0.1; 95% CI, 0.02-0.3). New tracheostomy procedures were uncommon (n = 43, 0.7%). Finally, there was substantial regional variation in postoperative IMV after spinal fusion, with patients in the Northeast vs. Midwest region having greater odds of greater than or equal to 4 days of postoperative IMV (aOR, 3.1; 95% CI, 1.9-5.0).</p><p><strong>Conclusions: </strong>One-in-eight children required greater than or equal to 4 days of IMV after spinal fusion. Chronic conditions affecting the neurologic, respiratory, skin/subcutaneous tissue, hematologic, endocrine/metabolic, genitourinary, and cardiac systems were associated with postoperative IMV. Further understanding of chronic conditions, clinical characteristics, and regional factors associated with duration of IMV may identify opportunities for improvements in care delivery.</p>\",\"PeriodicalId\":19760,\"journal\":{\"name\":\"Pediatric Critical Care Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Critical Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/PCC.0000000000003827\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PCC.0000000000003827","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Postoperative Mechanical Ventilation for Children With Medical Complexity Undergoing Spinal Fusion: A Pediatric Health Information System Database, 2016-2021 Cohort.
Objectives: To assess the prevalence and factors associated with duration of postoperative invasive mechanical ventilation (IMV) in children with medical complexity undergoing spinal fusion.
Design: Retrospective cohort study of the Pediatric Health Information System database.
Setting: Forty-seven tertiary referral U.S. children's hospitals.
Patients: Patients 5-18 years old with an underlying neuromuscular or genetic disorder admitted to the ICU following thoracic-lumbar spinal fusion for scoliosis, with hospital discharge between January 1, 2016, and December 31, 2021.
Interventions: None.
Measurements and main results: There were 6511 patients who met inclusion criteria, of which 438 (6.7%) had established preoperative tracheostomy and ventilator dependence. Three hundred seventy-two (5.7%) and 458 (7%) patients underwent postoperative IMV for 4-6 days and greater than or equal to 7 days, respectively. Chronic conditions associated with greater odds of greater than or equal to 4 days of postoperative IMV (as shown by adjusted odds ratio [aOR, 95% CI]), included diseases affecting the following systems: neurologic (aOR, 3.5; 95% CI, 2.5-5.0), respiratory (aOR, 2.8; 95% CI, 2.3-3.5), skin/subcutaneous tissue (aOR, 1.5; 95% CI, 1.2-2.1), hematologic (aOR, 1.4; 95% CI, 1.1-1.7), endocrine/metabolic (aOR, 1.3; 95% CI, 1.1-1.6), genitourinary (aOR, 1.3; 95% CI, 1.1-1.7), and cardiac (aOR, 1.3; 95% CI, 1.0-1.7). Established preoperative tracheostomy was associated with lower odds of greater than or equal to 4 days of postoperative IMV (aOR, 0.1; 95% CI, 0.02-0.3). New tracheostomy procedures were uncommon (n = 43, 0.7%). Finally, there was substantial regional variation in postoperative IMV after spinal fusion, with patients in the Northeast vs. Midwest region having greater odds of greater than or equal to 4 days of postoperative IMV (aOR, 3.1; 95% CI, 1.9-5.0).
Conclusions: One-in-eight children required greater than or equal to 4 days of IMV after spinal fusion. Chronic conditions affecting the neurologic, respiratory, skin/subcutaneous tissue, hematologic, endocrine/metabolic, genitourinary, and cardiac systems were associated with postoperative IMV. Further understanding of chronic conditions, clinical characteristics, and regional factors associated with duration of IMV may identify opportunities for improvements in care delivery.
期刊介绍:
Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.